Urology Coding Alert

Steer clear of reporting E/M services under their names.

One of our Codify members recently asked a question about billing guidelines for a licensed surgical assistant (LSA) in Texas. The subscriber wrote:

Under CMS billing guidelines, can an LSA who is not surgically assisting a physician provide and bill for medical services rendered in a physician office clinic? We’re looking at medical services such as new patient and follow-up visits, cystoscopic procedures, Testopel pellet implantation, penile injections, ultrasound procedures, and PVR/flow rate. A nurse practitioner, physician assistant, or clinical nurse specialist might normally provide these services. Would the LSA be deemed a Qualified Medical Professional or Clinical Staff for these types of services? And can an LSA perform and bill for E/M services?

The answer: According to The American Board of Surgical Assistants, a licensed surgical assistant’s main function is to assist a primary surgeon during an operative procedure where a surgical assistant is necessary and required. Under guidance and/or supervision of the primary operating surgeon, the licensed surgical assistant assists in the perioperative care of the patient and may also perform the following duties:

1. Assist in patient positioning
2. Placement of pneumatic tourniquet
3. Placement of urinary catheter
4. Prepping of surgical site
5. Draping patient with surgeon’s guidance
6. Assist in maintaining hemostasis
7. Retracting tissues to improve vision of the operative site
8. Use of electrocautery
9. Clamping, ligation, cutting of tissues at the surgeons directives
10. Closure of wound layers under the direct supervision of the surgeon
11. Assisting at endoscopic and laparoscopic procedures using the camera and other instrumentation

A licensed surgical assistant is not qualified or credentialed to perform or bill evaluation and management (E/M) services; he or she also cannot act as a primary surgeon for minor or major procedures. Most Medicare, Medicaid, and commercial carriers do not reimburse for the services of licensed surgical assistants. So check with the insurance carrier before billing for their assisting surgical services.